This Small Business Innovation Research Phase II project is to develop robot-based content to target upper extremity movement therapy goals and evaluate the clinical efficacy of the CosmoBot Robotics System as a therapy intervention for children diagnosed with cerebral palsy, brain injury, and stroke. Cerebral palsy is the most prevalent and one of the three most common physical impairment for children of ages 17 and under, with a prevalence of 2.6% and an incidence of 43/100,000 children per year. The incidence of brain injury among school aged children has been estimated by the CDC as 90 per 100,000 resulting in the addition of 60,000 children with new brain injuries annually. The incidence of stroke in neonatal children (<1 months of age) has been estimated by the CDC as 1:4000 and for children from 2 months to 18 years as 14.5:100,000. The CosmoBot system is developed by AnthroTronix, Inc., a human factors engineering company. The technology is centered around CosmoBot, a child-friendly robot controlled by various interfaces adapted to individual needs, regardless of physical limitations. The child controls the robot via gestures. Gestures may include reaching for a button, operating a joystick, or activating wearable sensors through body movement. The CosmoBot system allows the child to interact with its environment, giving the child a sense of control. In addition, the robot imitates movements, providing feedback and motivation for learning. The proposed project is to develop specific robot-based activities to maximize the CosmoBot system's effectiveness in targeting therapy goals and motivating children with neurological impairments. Specific Aim 1 is to design and develop the robot-based activities in software, targeting therapy goals for children with neurological impairments, and integrating the software into the system's already-existing software architecture. Specific Aim 2 is to evaluate CosmoBot's effectiveness as an intervention tool and assessing functional outcomes. Specific Aim 2 will be carried out with 20 subjects, ages 3-10, diagnosed with cerebral palsy, brain injury, or stroke and receiving outpatient therapy at the Mount Washington Pediatric Hospital, Cheverly, MD or the Mayo Clinic, Rochester, MN. A blinded, double cross-over experimental design will be used. Interventions will be developed utilizing the CosmoBot system for a specific therapeutic goal for each child and will be compared directly to conventional therapy for the same therapeutic goal. The metrics for success are whether the CosmoBot system is just as, or more, effective, in targeting identified therapy goals and in engaging young children, and whether the system is easy for therapists to use and is accepted by children and parents as a positive component for therapy. Of children with physical disabilities, many require ongoing physical and occupational therapy to optimize their movement capabilities in order for them to participate in family, school and recreational activities. The most common neurological disorders of the brain, which impact the physical ability of children are cerebral palsy, brain injury and stroke. This project will develop activities using a therapeutic toy robot, CosmoBot, to facilitate motor development and functional mobility of young children with movement impairments. Therapists in two locations will test the CosmoBot in order to evaluate how easy the system is to use, how much it appeals to the children, and whether it is effective in targeting therapy goals.